Reports blister Chicago psychiatric hospital for youths

When Garfield Park Hospital opened in February, the child psychiatric center promised to treat Chicago's toughest kids, including young gang members and sexually aggressive adolescents.

But Illinois officials stopped sending juvenile state wards to the 88-bed facility just a month later after reports of unsupervised teenagers attacking each other and medical records being altered to cover up problems, government records and interviews show.

Garfield Park's nursing director abruptly resigned about the same time, telling investigators for the state that she worried about the safety of both patients and staff, according to records and interviews.

Richard Calica, director of the Illinois Department of Children and Family Services, imposed an intake hold on the West Side facility on March 19, prohibiting further admission of DCFS wards there. Calica then dispatched a team of investigators from the University of Illinois at Chicago's psychiatry department to conduct an "emergency review" of conditions at Garfield Park, records show.

"This hospital was woefully unprepared when it first opened its doors to admit patients," the UIC team concluded in one of the two blistering reports it submitted to Calica in March and earlier this month.

After combing through patient records about youths punching each other and kicking staff, reviewing video surveillance of chaos on the units and interviewing youths and hospital workers, the UIC team said it found "significant quality of care deficits and patient safety issues ... that presented troubling risks of harm for DCFS wards."

The overall problems included "alteration or falsification of medical records," young patients repeatedly assaulting each other and staff, inexperienced and inadequately trained workers and high use of emergency medicines to sedate the teenagers, according to a UIC report. Patients also complained of being injured by staff who were trying to restrain them, the report said.

Garfield Park officials issued a written statement saying they had not received any reports from the UIC team or DCFS. "Based on the information provided by the Tribune, Garfield Park strongly disputes the accusations and allegations of the UIC team," the statement said. Facility administrators felt they had not been given an opportunity to disprove the accusations in the UIC reports and looked forward to doing so "in an appropriate venue and at an appropriate time," the statement said.

The administrators added that "the safety and well-being of our patients is Garfield Park's primary concern."

Granted a license Feb. 11 and opened a week later, the hospital soon held at least eight DCFS wards, while interviews suggest that more than a dozen additional youths were treated there. No state wards remain there today, DCFS spokesman Dave Clarkin said. The hospital would not comment on its current patient census.

The Garfield Park facility, at 520 N. Ridgeway Ave., had been dormant for several years until Universal spent more than $18 million on an extensive rehab, according to Universal and the facility's state license application.

Pennsylvania-based Universal, which operates 187 behavioral health facilities across the U.S. and last year generated revenue of more than $7 billion, dominates Illinois' youth treatment market.

Since 2008, DCFS has taken the unusual step of placing an intake hold on three other psychiatric hospitals run by Universal after allegations of abuse or improper care at those facilities. The agency stepped up its scrutiny of local psychiatric facilities that year after the Tribune documented allegations that several youths were sexually assaulted at the west suburban Riveredge psychiatric hospital amid haphazard monitoring by a patchwork of government agencies.

DCFS immediately stopped sending state wards to Riveredge and commissioned UIC to examine conditions there, as well as at other psychiatric facilities that serve Illinois wards. The UIC team produced highly critical reports alleging poor treatment of youths at Hartgrove Hospital in Chicago and Streamwood Behavioral Healthcare System in the western suburbs. DCFS has ongoing intake holds at those facilities as well as Riveredge.

Universal has long owned Hartgrove, and it acquired Riveredge and Streamwood in a 2010 merger with a rival health care firm.

The U.S. Justice Department and the inspector general for the U.S. Department of Health and Human Services have separately opened investigations into those three psychiatric facilities, as well as a Universal residential treatment center in Rockford, according to Universal's corporate filings and DCFS correspondence viewed by the Tribune. Universal and its executives and staff have not been accused of any wrongdoing, and the focus of the federal investigation is unclear.

State officials turn to psychiatric hospitals for short-term stabilization of teens in crisis and expect trained teams to ensure safety through constant clinical supervision of the locked units. Treatments should go beyond mere medication to include counseling and discharge plans that enable youths to make gains as they return home or step down to less restrictive settings.

But at Garfield Park, the UIC team said it found a litany of shortfalls.

In one instance, the UIC team said, facility administrators discharged a 16-year-old female state ward on a Sunday evening in March because other girls on the unit were targeting her for violent attacks, "and hospital staff did not feel they could keep her safe until the following day."

It's not clear whether that girl was sent home or to another therapeutic setting. That Sunday evening, according to the account of the former nursing director in the UIC report, Garfield Park's medical director issued a telephone order authorizing the girl's immediate discharge because the unit was too "volatile" to ensure her safety.

The charge nurse on duty also wrote a similar note in the chart about the chaotic situation on the unit, according to the UIC report.

The former nursing director told UIC that a top hospital official pulled those notes from the patient's chart the next day "and had the medical director and nurse rewrite their notes to exclude any mention of the unit being volatile or unsafe," the report said.

A hospital official told the nursing director that she could not believe how "stupid" the medical director was to "put something like that in writing," the UIC report said.

"DCFS will be all over us if they find out that we discharged a patient in the middle of the night," another hospital official told the nursing director, according to the UIC report.

Garfield Park's former nursing director, identified by the Tribune from separate public government records, did not respond to requests for comment.

The UIC team interviewed two juvenile state wards who complained of injuries suffered while they were being restrained by Garfield Park staff. "Both wards had visible scratches, abrasions or cuts," the UIC report said. Bruises and cuts on one girl's left arm were photographed by the UIC team as part of its report.

"Hospital staff lacked the appropriate skills to de-escalate patients' behaviors," a UIC report said, while youths "appear to have suffered harm as a result of such inadequate staff training and supervision."

In a separate case, no staff intervened for more than 20 minutes as surveillance cameras recorded an adolescent girl tearing apart a locked seclusion room, the UIC report said.

According to surveillance video later watched by the UIC team, the girl punched out a window on the room's door, ripped out the frame that held that window in place, then used the frame to break a mirror attached to the room's ceiling.

The girl scraped her wrist with a piece of the mirror, and when a second girl approached, the first one handed her shards of the broken mirror, the UIC report said. "Note: There is still no apparent intervention by staff at this point," the report said.

Finally, after more than 20 minutes, a nurse entered and gave the first girl a shot to quickly sedate her, the report said.

The hospital relied on frequent use of emergency medicines to manage behavior problems, "which may be related to the fact that staff training and experience ... appears to be woefully inadequate," the UIC report said.

One disruptive girl was sedated with emergency medicines 26 times during her 35-day stay at the hospital, the UIC report said.

Universal Senior Vice President Karen Johnson met briefly in March with UIC team leader Ron Davidson, who directs the university's mental health policy program, and acknowledged that the hospital's start-up had "obviously not gone well," according to the UIC report.

Johnson said Universal had imposed its own temporary intake hold on all new admissions effective March 20 — a day after DCFS had imposed its intake hold on the hospital, according to the UIC report. Johnson later sent Davidson an email explaining that Universal would use their hold on new admissions to train staff on "de-escalation strategies," according to the UIC report.

In its written statement to the Tribune, Garfield Park said: "After initial weeks of operations, Garfield Park elected to temporarily suspend admissions to provide enhanced training to our staff. During this process, non-ward patients remained at the facility receiving excellent care. Garfield Park Hospital is currently accepting patients and is looking forward to serving the greater Chicagoland community."